Pathology/Lab Coding Alert

Make sure you meet distinct service criteria before you unbundle. With the Office of Inspector General (OIG) encouraging CMS to institute stricter reviews for modifier 59 (Distinct procedural service) claims, you need to make sure you're using it correctly. Missteps on modifier 59 claims could mean lost $$ or fraud charges when your pathologist bills services bundled under CMS's Correct Coding Initiative (CCI). Listen to OIG Message On March 11, the OIG released its 202-page Compendium of Unimplemented OIG Recommendations, which revealed that many OIG suggestions have been ignored. Case in point: In 2003, the OIG found a 40 percent error rate on claims that contained modifier 59 when used to separate CCI edits, resulting in Medicare paying $59 million in improper payments. The OIG report suggested that CMS should update carriers' claims processing systems so they pay claims with modifier 59 only when the modifier is billed with the [...]